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Lee TF, Hsieh YW, Yang PY, Tseng CH, Lee SH, Yang J, Chang L, Wu JM, Tseng CD, Chao PJ. Using meta-analysis and CNN-NLP to review and classify the medical literature for normal tissue complication probability in head and neck cancer. Radiat Oncol 2024; 19:5. [PMID: 38195582 PMCID: PMC10775485 DOI: 10.1186/s13014-023-02381-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 11/20/2023] [Indexed: 01/11/2024] Open
Abstract
PURPOSE The study aims to enhance the efficiency and accuracy of literature reviews on normal tissue complication probability (NTCP) in head and neck cancer patients using radiation therapy. It employs meta-analysis (MA) and natural language processing (NLP). MATERIAL AND METHODS The study consists of two parts. First, it employs MA to assess NTCP models for xerostomia, dysphagia, and mucositis after radiation therapy, using Python 3.10.5 for statistical analysis. Second, it integrates NLP with convolutional neural networks (CNN) to optimize literature search, reducing 3256 articles to 12. CNN settings include a batch size of 50, 50-200 epoch range and a 0.001 learning rate. RESULTS The study's CNN-NLP model achieved a notable accuracy of 0.94 after 200 epochs with Adamax optimization. MA showed an AUC of 0.67 for early-effect xerostomia and 0.74 for late-effect, indicating moderate to high predictive accuracy but with high variability across studies. Initial CNN accuracy of 66.70% improved to 94.87% post-tuning by optimizer and hyperparameters. CONCLUSION The study successfully merges MA and NLP, confirming high predictive accuracy for specific model-feature combinations. It introduces a time-based metric, words per minute (WPM), for efficiency and highlights the utility of MA and NLP in clinical research.
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Affiliation(s)
- Tsair-Fwu Lee
- Medical Physics and Informatics Laboratory of Electronics Engineering, National Kaohsiung University of Science and Technology, No.415, Jiangong Rd., Sanmin Dist., Kaohsiung, 80778, Taiwan, ROC
- Graduate Institute of Clinical Medicine, Kaohsiung Medical University, Kaohsiung, 807, Taiwan, ROC
- Department of Medical Imaging and Radiological Sciences, Kaohsiung Medical University, Kaohsiung, 80708, Taiwan, ROC
| | - Yang-Wei Hsieh
- Medical Physics and Informatics Laboratory of Electronics Engineering, National Kaohsiung University of Science and Technology, No.415, Jiangong Rd., Sanmin Dist., Kaohsiung, 80778, Taiwan, ROC
| | - Pei-Ying Yang
- Medical Physics and Informatics Laboratory of Electronics Engineering, National Kaohsiung University of Science and Technology, No.415, Jiangong Rd., Sanmin Dist., Kaohsiung, 80778, Taiwan, ROC
| | - Chi-Hung Tseng
- Medical Physics and Informatics Laboratory of Electronics Engineering, National Kaohsiung University of Science and Technology, No.415, Jiangong Rd., Sanmin Dist., Kaohsiung, 80778, Taiwan, ROC
| | - Shen-Hao Lee
- Medical Physics and Informatics Laboratory of Electronics Engineering, National Kaohsiung University of Science and Technology, No.415, Jiangong Rd., Sanmin Dist., Kaohsiung, 80778, Taiwan, ROC
- Department of Radiation Oncology, Linkou Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Linkou, Taiwan, ROC
| | - Jack Yang
- Medical Physics at Monmouth Medical Center, Barnabas Health Care at Long Branch, Long Branch, NJ, USA
| | - Liyun Chang
- Department of Medical Imaging and Radiological Sciences, I-Shou University, Kaohsiung, 840, Taiwan, ROC
| | - Jia-Ming Wu
- Heavy Ion Center of Wuwei Cancer Hospital, Gansu Wuwei Academy of Medical Sciences, Gansu Wuwei Tumor Hospital, Wuwei, Gansu Province, China
- Department of Medical Physics, Chengde Medical University, Chengde, Hebei Province, China
| | - Chin-Dar Tseng
- Medical Physics and Informatics Laboratory of Electronics Engineering, National Kaohsiung University of Science and Technology, No.415, Jiangong Rd., Sanmin Dist., Kaohsiung, 80778, Taiwan, ROC
| | - Pei-Ju Chao
- Medical Physics and Informatics Laboratory of Electronics Engineering, National Kaohsiung University of Science and Technology, No.415, Jiangong Rd., Sanmin Dist., Kaohsiung, 80778, Taiwan, ROC.
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Lin CH, Hsu PI, Tseng CD, Chao PJ, Wu IT, Ghose S, Shih CA, Lee SH, Ren JH, Shie CB, Lee TF. Application of artificial intelligence in endoscopic image analysis for the diagnosis of a gastric cancer pathogen-Helicobacter pylori infection. Sci Rep 2023; 13:13380. [PMID: 37592004 PMCID: PMC10435453 DOI: 10.1038/s41598-023-40179-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 08/06/2023] [Indexed: 08/19/2023] Open
Abstract
Helicobacter pylori (H. pylori) infection is the principal cause of chronic gastritis, gastric ulcers, duodenal ulcers, and gastric cancer. In clinical practice, diagnosis of H. pylori infection by a gastroenterologists' impression of endoscopic images is inaccurate and cannot be used for the management of gastrointestinal diseases. The aim of this study was to develop an artificial intelligence classification system for the diagnosis of H. pylori infection by pre-processing endoscopic images and machine learning methods. Endoscopic images of the gastric body and antrum from 302 patients receiving endoscopy with confirmation of H. pylori status by a rapid urease test at An Nan Hospital were obtained for the derivation and validation of an artificial intelligence classification system. The H. pylori status was interpreted as positive or negative by Convolutional Neural Network (CNN) and Concurrent Spatial and Channel Squeeze and Excitation (scSE) network, combined with different classification models for deep learning of gastric images. The comprehensive assessment for H. pylori status by scSE-CatBoost classification models for both body and antrum images from same patients achieved an accuracy of 0.90, sensitivity of 1.00, specificity of 0.81, positive predictive value of 0.82, negative predicted value of 1.00, and area under the curve of 0.88. The data suggest that an artificial intelligence classification model using scSE-CatBoost deep learning for gastric endoscopic images can distinguish H. pylori status with good performance and is useful for the survey or diagnosis of H. pylori infection in clinical practice.
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Affiliation(s)
- Chih-Hsueh Lin
- Department of Electronic Engineering, National Kaohsiung University of Science and Technology, Kaohsiung, 80778, Taiwan
- Medical Physics and Informatics Laboratory of Electronic Engineering, National Kaohsiung University of Science and Technology, Kaohsiung, 80778, Taiwan
| | - Ping-I Hsu
- Division of Gastroenterology, Department of Medicine, An Nan Hospital, China Medical University, Tainan, Taiwan
| | - Chin-Dar Tseng
- Department of Electronic Engineering, National Kaohsiung University of Science and Technology, Kaohsiung, 80778, Taiwan.
- Medical Physics and Informatics Laboratory of Electronic Engineering, National Kaohsiung University of Science and Technology, Kaohsiung, 80778, Taiwan.
| | - Pei-Ju Chao
- Department of Electronic Engineering, National Kaohsiung University of Science and Technology, Kaohsiung, 80778, Taiwan
- Medical Physics and Informatics Laboratory of Electronic Engineering, National Kaohsiung University of Science and Technology, Kaohsiung, 80778, Taiwan
| | - I-Ting Wu
- Division of Gastroenterology, Department of Medicine, An Nan Hospital, China Medical University, Tainan, Taiwan
| | - Supratip Ghose
- Department of Education and Research, An Nan Hospital, China Medical University, Tainan, Taiwan
| | - Chih-An Shih
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Antai Medical Care Corporation, Antai Tian-Sheng Memorial Hospital, Donggan, Pingtung County, Taiwan
- Department of Nursing, Meiho University, Neipu, Pingtung County, Taiwan
| | - Shen-Hao Lee
- Department of Electronic Engineering, National Kaohsiung University of Science and Technology, Kaohsiung, 80778, Taiwan
- Medical Physics and Informatics Laboratory of Electronic Engineering, National Kaohsiung University of Science and Technology, Kaohsiung, 80778, Taiwan
- Department of Radiation Oncology, Linkou Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Linkou, Taiwan
| | - Jia-Hong Ren
- Department of Electronic Engineering, National Kaohsiung University of Science and Technology, Kaohsiung, 80778, Taiwan
- Medical Physics and Informatics Laboratory of Electronic Engineering, National Kaohsiung University of Science and Technology, Kaohsiung, 80778, Taiwan
| | - Chang-Bih Shie
- Division of Gastroenterology, Department of Medicine, An Nan Hospital, China Medical University, Tainan, Taiwan
| | - Tsair-Fwu Lee
- Department of Electronic Engineering, National Kaohsiung University of Science and Technology, Kaohsiung, 80778, Taiwan.
- Medical Physics and Informatics Laboratory of Electronic Engineering, National Kaohsiung University of Science and Technology, Kaohsiung, 80778, Taiwan.
- Department of Medical Imaging and Radiological Sciences, Kaohsiung Medical University, Kaohsiung, 80708, Taiwan.
- PhD Program in Biomedical Engineering, Kaohsiung Medical University, Kaohsiung, 80708, Taiwan.
- School of Dentistry, College of Dental Medicine, Kaohsiung Medical University, Kaohsiung, 80708, Taiwan.
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Chao PJ, Chang L, Kang CL, Lin CH, Shieh CS, Wu JM, Tseng CD, Tsai IH, Hsu HC, Huang YJ, Lee TF. Using deep learning models to analyze the cerebral edema complication caused by radiotherapy in patients with intracranial tumor. Sci Rep 2022; 12:1555. [PMID: 35091636 PMCID: PMC8799730 DOI: 10.1038/s41598-022-05455-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 01/10/2022] [Indexed: 11/09/2022] Open
Abstract
Using deep learning models to analyze patients with intracranial tumors, to study the image segmentation and standard results by clinical depiction complications of cerebral edema after receiving radiotherapy. In this study, patients with intracranial tumors receiving computer knife (CyberKnife M6) stereotactic radiosurgery were followed using the treatment planning system (MultiPlan 5.1.3) to obtain before-treatment and four-month follow-up images of patients. The TensorFlow platform was used as the core architecture for training neural networks. Supervised learning was used to build labels for the cerebral edema dataset by using Mask region-based convolutional neural networks (R-CNN), and region growing algorithms. The three evaluation coefficients DICE, Jaccard (intersection over union, IoU), and volumetric overlap error (VOE) were used to analyze and calculate the algorithms in the image collection for cerebral edema image segmentation and the standard as described by the oncologists. When DICE and IoU indices were 1, and the VOE index was 0, the results were identical to those described by the clinician.The study found using the Mask R-CNN model in the segmentation of cerebral edema, the DICE index was 0.88, the IoU index was 0.79, and the VOE index was 2.0. The DICE, IoU, and VOE indices using region growing were 0.77, 0.64, and 3.2, respectively. Using the evaluated index, the Mask R-CNN model had the best segmentation effect. This method can be implemented in the clinical workflow in the future to achieve good complication segmentation and provide clinical evaluation and guidance suggestions.
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Affiliation(s)
- Pei-Ju Chao
- Department of Electronics Engineering, National Kaohsiung University of Science and Technology, Kaohsiung, 80778, Taiwan, ROC.,Medical Physics and Informatics Laboratory of Electronics Engineering, National Kaohsiung University of Science and Technology, Kaohsiung, 80778, Taiwan, ROC.,Department of Radiation Oncology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, 83342, Taiwan, ROC
| | - Liyun Chang
- Department of Medical Imaging and Radiological Sciences, I-Shou University, Kaohsiung, 82445, Taiwan, ROC
| | - Chen-Lin Kang
- Department of Radiation Oncology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, 83342, Taiwan, ROC
| | - Chin-Hsueh Lin
- Department of Electronics Engineering, National Kaohsiung University of Science and Technology, Kaohsiung, 80778, Taiwan, ROC
| | - Chin-Shiuh Shieh
- Department of Electronics Engineering, National Kaohsiung University of Science and Technology, Kaohsiung, 80778, Taiwan, ROC
| | - Jia-Ming Wu
- Department of Biomedicine Engineering, Chengde Medical University, Chengde Hebei, 067000, China
| | - Chin-Dar Tseng
- Department of Electronics Engineering, National Kaohsiung University of Science and Technology, Kaohsiung, 80778, Taiwan, ROC.,Medical Physics and Informatics Laboratory of Electronics Engineering, National Kaohsiung University of Science and Technology, Kaohsiung, 80778, Taiwan, ROC
| | - I-Hsing Tsai
- Department of Electronics Engineering, National Kaohsiung University of Science and Technology, Kaohsiung, 80778, Taiwan, ROC
| | - Hsuan-Chih Hsu
- Department of Radiation Oncology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, 83342, Taiwan, ROC
| | - Yu-Jie Huang
- Medical Physics and Informatics Laboratory of Electronics Engineering, National Kaohsiung University of Science and Technology, Kaohsiung, 80778, Taiwan, ROC.
| | - Tsair-Fwu Lee
- Department of Electronics Engineering, National Kaohsiung University of Science and Technology, Kaohsiung, 80778, Taiwan, ROC. .,Medical Physics and Informatics Laboratory of Electronics Engineering, National Kaohsiung University of Science and Technology, Kaohsiung, 80778, Taiwan, ROC. .,PhD Program in Biomedical Engineering, Kaohsiung Medical University, Kaohsiung, 80708, Taiwan, ROC.
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Chao PJ, Tsai IH, Huang CC, Lin CH, Shieh CS, Hsieh YW, Yang PY, Lee HF, Lee TF. Radiation-Induced Secondary Cancer Risk Assessment in Patients With Lung Cancer After Stereotactic Body Radiotherapy Using the CyberKnife M6 System With Lung-Optimized Treatment. Front Bioeng Biotechnol 2020; 8:306. [PMID: 32457880 PMCID: PMC7223476 DOI: 10.3389/fbioe.2020.00306] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Accepted: 03/20/2020] [Indexed: 12/21/2022] Open
Abstract
Background To evaluate the lifetime secondary cancer risk (SCR) of stereotactic body radiotherapy (SBRT) using the CyberKnife (CK) M6 system with a lung-optimized treatment (LOT) module for lung cancer patients. Methods We retrospectively enrolled 11 lung cancer patients curatively treated with SBRT using the CK M6 robotic radiosurgery system. The planning treatment volume (PTV) and common organs at risk (OARs) for SCR analysis included the spinal cord, total lung, and healthy normal lung tissue (total lung volume - PTV). Schneider’s full model was used to calculate SCR according to the concept of organ equivalent dose (OED). Results CK-LOT-SBRT delivers precisely targeted radiation doses to lung cancers and achieves good PTV coverage and conformal dose distribution, thus posing limited SCR to surrounding tissues. The three OARs had similar risk equivalent dose (RED) values among four different models. However, for the PTV, differences in RED values were observed among the models. The cumulative excess absolute risk (EAR) value for the normal lung, spinal cord, and PTV was 70.47 (per 10,000 person-years). Schneider’s Lnt model seemed to overestimate the EAR/lifetime attributable risk (LAR). Conclusion For lung cancer patients treated with CK-LOT optimized with the Monte Carlo algorithm, the SCR might be lower. Younger patients had a greater SCR, although the dose–response relationship seemed be non-linear for the investigated organs, especially with respect to the PTV. Despite the etiological association, the SCR after CK-LOT-SBRT for carcinoma and sarcoma, is low, but not equal to zero. Further research is required to understand and to show the lung SBRT SCR comparisons and differences across different modalities with motion management strategies.
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Affiliation(s)
- Pei-Ju Chao
- Medical Physics and Informatics Laboratory of Electronics Engineering, National Kaohsiung University of Science and Technology, Kaohsiung, Taiwan.,Department of Radiation Oncology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - I-Hsing Tsai
- Medical Physics and Informatics Laboratory of Electronics Engineering, National Kaohsiung University of Science and Technology, Kaohsiung, Taiwan
| | - Chun-Chieh Huang
- Department of Radiation Oncology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chih-Hsueh Lin
- Medical Physics and Informatics Laboratory of Electronics Engineering, National Kaohsiung University of Science and Technology, Kaohsiung, Taiwan
| | - Chin-Shiuh Shieh
- Medical Physics and Informatics Laboratory of Electronics Engineering, National Kaohsiung University of Science and Technology, Kaohsiung, Taiwan
| | - Yang-Wei Hsieh
- Medical Physics and Informatics Laboratory of Electronics Engineering, National Kaohsiung University of Science and Technology, Kaohsiung, Taiwan.,Department of Radiation Oncology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Pei-Ying Yang
- Medical Physics and Informatics Laboratory of Electronics Engineering, National Kaohsiung University of Science and Technology, Kaohsiung, Taiwan.,Department of Radiation Oncology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Hsiao-Fei Lee
- Medical Physics and Informatics Laboratory of Electronics Engineering, National Kaohsiung University of Science and Technology, Kaohsiung, Taiwan.,Department of Radiation Oncology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Tsair-Fwu Lee
- Medical Physics and Informatics Laboratory of Electronics Engineering, National Kaohsiung University of Science and Technology, Kaohsiung, Taiwan.,Department of Radiation Oncology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.,Biomedical Engineering, Kaohsiung Medical University, Kaohsiung, Taiwan
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Huang CC, Chao PJ, Guo SS, Wang CJ, Luo HL, Su YL, Lee TF, Fang FM. Developing a multivariable normal tissue complication probability model to predict late rectal bleeding following intensity-modulated radiation therapy. J Cancer 2019; 10:2588-2593. [PMID: 31258765 PMCID: PMC6584341 DOI: 10.7150/jca.29606] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Accepted: 04/27/2019] [Indexed: 12/01/2022] Open
Abstract
Purpose: To develop a multivariable normal tissue complication probability (NTCP) model to predict moderate to severe late rectal bleeding following intensity-modulated radiation therapy (IMRT). Methods and materials: Sixty-eight patients with localized prostate cancer treated by IMRT from 2008 to 2011 were enrolled. The median follow-up time was 56 months. According to the criteria of D'Amico risk classifications, there were 9, 20 and 39 patients in low, intermediate and high-risk groups, respectively. Forty-two patients were combined with androgen deprivation therapy. Fifteen patients had suffered from grade 2 or more (grade 2+) late rectal bleeding. The numbers of predictors for a multivariable logistic regression NTCP model were determined by the least absolute shrinkage and selection operator (LASSO). Results: The most important predictors for late rectal bleeding ranked by LASSO were platelet count, risk group and the relative volume of rectum receiving at least 65 Gy (V65). The NTCP model of grade 2+ rectal bleeding was as follows: S = -17.49 + Platelets (1000/μL) * (-0.025) + Risk group * Corresponding coefficient (low-risk group = 0; intermediate-risk group = 19.07; high-risk group = 20.41) + V65 * 0.045. Conclusions: A LASSO-based multivariable NTCP model comprising three important predictors (platelet count, risk group and V65) was established to predict the incidence of grade 2+ late rectal bleeding after IMRT.
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Affiliation(s)
- Chun-Chieh Huang
- Department of Radiation Oncology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.,Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Pei-Ju Chao
- Department of Radiation Oncology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.,Medical Physics and Informatics Laboratory of Electronics Engineering, National Kaohsiung University of Science and Technology, Kaohsiung, Taiwan
| | - Shih-Sian Guo
- Department of Radiation Oncology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.,Medical Physics and Informatics Laboratory of Electronics Engineering, National Kaohsiung University of Science and Technology, Kaohsiung, Taiwan
| | - Chong-Jong Wang
- Department of Radiation Oncology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Hao-Lun Luo
- Department of Urology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Yu-Li Su
- Division of Hematology-Oncology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Tsair-Fwu Lee
- Department of Radiation Oncology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.,Medical Physics and Informatics Laboratory of Electronics Engineering, National Kaohsiung University of Science and Technology, Kaohsiung, Taiwan.,Graduate Institute of Clinical Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Fu-Min Fang
- Department of Radiation Oncology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
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Hsu TH, Chao PJ, Huang YT, Bezyak JL, Ososkie JN. Affective Reactions of Vietnamese Toward Coworkers With Disabilities and Perceptions of Community Inclusion. Rehabilitation Counseling Bulletin 2018. [DOI: 10.1177/0034355218804356] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Vietnam is in the emerging stage in supporting and protecting people with disabilities (PWDs) in terms of employment rights and opportunities. The main purpose of this study was to explore how Vietnamese perceive their coworkers with disabilities in general workplace settings. In addition, the secondary objective of this study was to explore how Vietnamese perceive community acceptance and inclusive education of PWDs in different environmental contexts. Results indicated participants had generally positive affective reactions toward their coworkers with disabilities in the workplace. However, findings also indicated that Vietnamese people possessed hierarchical attitudes toward people with different types of disabilities in terms of community acceptance and educational rights.
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Lee TF, Sung KC, Chao PJ, Huang YJ, Lan JH, Wu HY, Chang L, Ting HM. Relationships among patient characteristics, irradiation treatment planning parameters, and treatment toxicity of acute radiation dermatitis after breast hybrid intensity modulation radiation therapy. PLoS One 2018; 13:e0200192. [PMID: 30011291 PMCID: PMC6047778 DOI: 10.1371/journal.pone.0200192] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Accepted: 06/21/2018] [Indexed: 02/06/2023] Open
Abstract
To evaluate the relationships among patient characteristics, irradiation treatment planning parameters, and treatment toxicity of acute radiation dermatitis (RD) after breast hybrid intensity modulation radiation therapy (IMRT). The study cohort consisted of 95 breast cancer patients treated with hybrid IMRT. RD grade ≥2 (2+) toxicity was defined as clinically significant. Patient characteristics and the irradiation treatment planning parameters were used as the initial candidate factors. Prognostic factors were identified using the least absolute shrinkage and selection operator (LASSO)-based normal tissue complication probability (NTCP) model. A univariate cut-off dose NTCP model was developed to find the dose-volume limitation. Fifty-two (54.7%) of ninety-five patients experienced acute RD grade 2+ toxicity. The volume of skin receiving a dose >35 Gy (V35) was the most significant dosimetric predictor associated with RD grade 2+ toxicity. The NTCP model parameters for V35Gy were TV50 = 85.7 mL and γ50 = 0.77, where TV50 was defined as the volume corresponding to a 50% incidence of complications, and γ50 was the normalized slope of the volume-response curve. Additional potential predictive patient characteristics were energy and surgery, but the results were not statistically significant. To ensure a better quality of life and compliance for breast hybrid IMRT patients, the skin volume receiving a dose >35 Gy should be limited to <85.7 mL to keep the incidence of RD grade 2+ toxicities below 50%. To avoid RD toxicity, the volume of skin receiving a dose >35 Gy should follow sparing tolerance and the inherent patient characteristics should be considered.
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Affiliation(s)
- Tsair-Fwu Lee
- Medical Physics and Informatics Laboratory of Electronics Engineering, National Kaohsiung University of Science and Technology, Kaohsiung, Taiwan, ROC.,Graduate Institute of Clinical Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan, ROC.,Department of Radiation Oncology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan, ROC
| | - Kuo-Chiang Sung
- Department of Radiation Oncology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan, ROC.,Department of Electrical Engineering, National Kaohsiung University of Science and Technology, Kaohsiung, Taiwan, ROC
| | - Pei-Ju Chao
- Medical Physics and Informatics Laboratory of Electronics Engineering, National Kaohsiung University of Science and Technology, Kaohsiung, Taiwan, ROC.,Department of Radiation Oncology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan, ROC
| | - Yu-Jie Huang
- Department of Radiation Oncology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan, ROC
| | - Jen-Hong Lan
- Medical Physics and Informatics Laboratory of Electronics Engineering, National Kaohsiung University of Science and Technology, Kaohsiung, Taiwan, ROC.,Department of Radiation Oncology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan, ROC
| | - Horng-Yuan Wu
- Department of Electrical Engineering, National Kaohsiung University of Science and Technology, Kaohsiung, Taiwan, ROC
| | - Liyun Chang
- Department of Medical Imaging and Radiological Sciences, I-Shou University, Kaohsiung, Taiwan, ROC
| | - Hui-Min Ting
- Medical Physics and Informatics Laboratory of Electronics Engineering, National Kaohsiung University of Science and Technology, Kaohsiung, Taiwan, ROC.,Department of Radiation Oncology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan, ROC
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Lee HF, Lan JH, Chao PJ, Ting HM, Chen HC, Hsu HC, Lee TF. Radiation-induced secondary malignancies for nasopharyngeal carcinoma: a pilot study of patients treated via IMRT or VMAT. Cancer Manag Res 2018; 10:131-141. [PMID: 29403311 PMCID: PMC5783017 DOI: 10.2147/cmar.s145713] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Patients treated with radiotherapy are at risk of developing a second cancer during their lifetime, which can directly impact treatment decision-making and patient management. The aim of this study was to qualify and compare the secondary cancer risk (SCR) after intensity-modulated radiation therapy (IMRT) and volumetric-modulated arc therapy (VMAT) in nasopharyngeal carcinoma (NPC) patients. Patients and methods We analyzed the treatment plans of a cohort of 10 NPC patients originally treated with IMRT or VMAT. Dose distributions in these plans were used to calculate the organ equivalent dose (OED) with Schneider’s full model. Analyses were applied to the brain stem, spinal cord, oral cavity, pharynx, parotid glands, lung, mandible, healthy tissue, and planning target volume. Results We observed that the OED-based risks of SCR were slightly higher for the oral cavity and mandible when VMAT was used. No significant difference was found in terms of the doses to other organs, including the brain stem, parotids, pharynx, submandibular gland, lung, spinal cord, and healthy tissue. In the NPC cohort, the lungs were the organs that were most sensitive to radiation-induced cancer. Conclusion VMAT afforded superior results in terms of organ-at-risk-sparing compared with IMRT. Most OED-based second cancer risks for various organs were similar when VMAT and IMRT were employed, but the risks for the oral cavity and mandible were slightly higher when VMAT was used.
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Affiliation(s)
- Hsiao-Fei Lee
- Medical Physics and Informatics Laboratory of Electronics Engineering, National Kaohsiung University of Applied Sciences, Kaohsiung, Taiwan, Republic of China.,Department of Radiation Oncology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan, Republic of China
| | - Jen-Hong Lan
- Medical Physics and Informatics Laboratory of Electronics Engineering, National Kaohsiung University of Applied Sciences, Kaohsiung, Taiwan, Republic of China.,Department of Radiation Oncology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan, Republic of China
| | - Pei-Ju Chao
- Medical Physics and Informatics Laboratory of Electronics Engineering, National Kaohsiung University of Applied Sciences, Kaohsiung, Taiwan, Republic of China.,Department of Radiation Oncology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan, Republic of China
| | - Hui-Min Ting
- Medical Physics and Informatics Laboratory of Electronics Engineering, National Kaohsiung University of Applied Sciences, Kaohsiung, Taiwan, Republic of China.,Department of Radiation Oncology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan, Republic of China
| | - Hui-Chun Chen
- Department of Radiation Oncology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan, Republic of China
| | - Hsuan-Chih Hsu
- Department of Radiation Oncology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan, Republic of China
| | - Tsair-Fwu Lee
- Medical Physics and Informatics Laboratory of Electronics Engineering, National Kaohsiung University of Applied Sciences, Kaohsiung, Taiwan, Republic of China.,Department of Radiation Oncology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan, Republic of China.,Graduate Institute of Clinical Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan, Republic of China.,Department of Radiation Oncology, Kaohsiung Yuan's General Hospital, Kaohsiung, Taiwan, Republic of China
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Chao PJ, Lee HF, Lan JH, Guo SS, Ting HM, Huang YJ, Chen HC, Lee TF. Propensity-score-matched evaluation of the incidence of radiation pneumonitis and secondary cancer risk for breast cancer patients treated with IMRT/VMAT. Sci Rep 2017; 7:13771. [PMID: 29062118 PMCID: PMC5653804 DOI: 10.1038/s41598-017-14145-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Accepted: 10/05/2017] [Indexed: 11/09/2022] Open
Abstract
Propensity score matching evaluates the treatment incidence of radiation-induced pneumonitis (RP) and secondary cancer risk (SCR) after intensity-modulated radiotherapy (IMRT) and volumetric-modulated arc therapy (VMAT) for breast cancer patients. Of 32 patients treated with IMRT and 58 who received VMAT were propensity matched in a 1:1 ratio. RP and SCR were evaluated as the endpoints of acute and chronic toxicity, respectively. Self-fitted normal tissue complication probability (NTCP) parameter values were used to analyze the risk of RP. SCRs were evaluated using the preferred Schneider's parameterization risk models. The dosimetric parameter of the ipsilateral lung volume receiving 40 Gy (IV40) was selected as the dominant risk factor for the RP NTCP model. The results showed that the risks of RP and NTCP, as well as that of SCR of the ipsilateral lung, were slightly lower than the values in patients treated with VMAT versus IMRT (p ≤ 0.01). However, the organ equivalent dose and excess absolute risk values in the contralateral lung and breast were slightly higher with VMAT than with IMRT (p ≤ 0.05). When compared to IMRT, VMAT is a rational radiotherapy option for breast cancer patients, based on its reduced potential for inducing secondary malignancies and RP complications.
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Affiliation(s)
- Pei-Ju Chao
- Medical Physics and Informatics Laboratory of Electronics Engineering, National Kaohsiung University of Applied Sciences, Kaohsiung, 80778, Taiwan, ROC.,Department of Radiation Oncology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, 83342, Taiwan, ROC
| | - Hsiao-Fei Lee
- Medical Physics and Informatics Laboratory of Electronics Engineering, National Kaohsiung University of Applied Sciences, Kaohsiung, 80778, Taiwan, ROC.,Department of Radiation Oncology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, 83342, Taiwan, ROC
| | - Jen-Hong Lan
- Medical Physics and Informatics Laboratory of Electronics Engineering, National Kaohsiung University of Applied Sciences, Kaohsiung, 80778, Taiwan, ROC.,Department of Radiation Oncology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, 83342, Taiwan, ROC
| | - Shih-Sian Guo
- Medical Physics and Informatics Laboratory of Electronics Engineering, National Kaohsiung University of Applied Sciences, Kaohsiung, 80778, Taiwan, ROC.,Department of Radiation Oncology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, 83342, Taiwan, ROC
| | - Hui-Min Ting
- Medical Physics and Informatics Laboratory of Electronics Engineering, National Kaohsiung University of Applied Sciences, Kaohsiung, 80778, Taiwan, ROC.,Department of Radiation Oncology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, 83342, Taiwan, ROC
| | - Yu-Jie Huang
- Department of Radiation Oncology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, 83342, Taiwan, ROC
| | - Hui-Chun Chen
- Department of Radiation Oncology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, 83342, Taiwan, ROC.
| | - Tsair-Fwu Lee
- Medical Physics and Informatics Laboratory of Electronics Engineering, National Kaohsiung University of Applied Sciences, Kaohsiung, 80778, Taiwan, ROC. .,Department of Radiation Oncology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, 83342, Taiwan, ROC. .,Graduate Institute of Clinical Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan, ROC. .,Department of Radiation Oncology, Kaohsiung Yuan's General Hospital, Kaohsiung, 80249, Taiwan, ROC.
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Shieh CS, Tseng CD, Chang LY, Lin WC, Wu LF, Wang HY, Chao PJ, Chiu CL, Lee TF. Synthesis of vibroarthrographic signals in knee osteoarthritis diagnosis training. BMC Res Notes 2016; 9:352. [PMID: 27435313 PMCID: PMC4950531 DOI: 10.1186/s13104-016-2156-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Accepted: 07/13/2016] [Indexed: 11/30/2022] Open
Abstract
Background Vibroarthrographic (VAG) signals are used as useful indicators of knee osteoarthritis (OA) status. The objective was to build a template database of knee crepitus sounds. Internships can practice in the template database to shorten the time of training for diagnosis of OA. Methods A knee sound signal was obtained using an innovative stethoscope device with a goniometer. Each knee sound signal was recorded with a Kellgren–Lawrence (KL) grade. The sound signal was segmented according to the goniometer data. The signal was Fourier transformed on the correlated frequency segment. An inverse Fourier transform was performed to obtain the time-domain signal. Haar wavelet transform was then done. The median and mean of the wavelet coefficients were chosen to inverse transform the synthesized signal in each KL category. The quality of the synthesized signal was assessed by a clinician. Results The sample signals were evaluated using different algorithms (median and mean). The accuracy rate of the median coefficient algorithm (93 %) was better than the mean coefficient algorithm (88 %) for cross-validation by a clinician using synthesis of VAG. Conclusions The artificial signal we synthesized has the potential to build a learning system for medical students, internships and para-medical personnel for the diagnosis of OA. Therefore, our method provides a feasible way to evaluate crepitus sounds that may assist in the diagnosis of knee OA.
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Affiliation(s)
- Chin-Shiuh Shieh
- Medical Physics and Informatics Laboratory of Electronics Engineering, National Kaohsiung University of Applied Sciences, 415, Chien Kung Road, San-Min District, Kaohsiung, 807, Taiwan, ROC.,Graduate Institute of Clinical Medicine, Kaohsiung Medical University, Kaohsiung, 807, Taiwan, ROC
| | - Chin-Dar Tseng
- Medical Physics and Informatics Laboratory of Electronics Engineering, National Kaohsiung University of Applied Sciences, 415, Chien Kung Road, San-Min District, Kaohsiung, 807, Taiwan, ROC
| | - Li-Yun Chang
- Department of Medical Imaging and Radiological Sciences, I-Shou University, Kaohsiung, 82445, Taiwan, ROC
| | - Wei-Chun Lin
- Institute of Photonics and Communications, National Kaohsiung University of Applied Sciences, Kaohsiung, 80778, Taiwan, ROC.,Department of Orthopedic, Kaohsiung Municipal Min-Sheng Hospital, Kaohsiung, 80276, Taiwan, ROC
| | - Li-Fu Wu
- Medical Physics and Informatics Laboratory of Electronics Engineering, National Kaohsiung University of Applied Sciences, 415, Chien Kung Road, San-Min District, Kaohsiung, 807, Taiwan, ROC
| | - Hung-Yu Wang
- Medical Physics and Informatics Laboratory of Electronics Engineering, National Kaohsiung University of Applied Sciences, 415, Chien Kung Road, San-Min District, Kaohsiung, 807, Taiwan, ROC.,Graduate Institute of Clinical Medicine, Kaohsiung Medical University, Kaohsiung, 807, Taiwan, ROC
| | - Pei-Ju Chao
- Medical Physics and Informatics Laboratory of Electronics Engineering, National Kaohsiung University of Applied Sciences, 415, Chien Kung Road, San-Min District, Kaohsiung, 807, Taiwan, ROC.,Department of Radiation Oncology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, 83342, Taiwan, ROC
| | - Chien-Liang Chiu
- Medical Physics and Informatics Laboratory of Electronics Engineering, National Kaohsiung University of Applied Sciences, 415, Chien Kung Road, San-Min District, Kaohsiung, 807, Taiwan, ROC
| | - Tsair-Fwu Lee
- Medical Physics and Informatics Laboratory of Electronics Engineering, National Kaohsiung University of Applied Sciences, 415, Chien Kung Road, San-Min District, Kaohsiung, 807, Taiwan, ROC. .,Graduate Institute of Clinical Medicine, Kaohsiung Medical University, Kaohsiung, 807, Taiwan, ROC.
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Lee TF, Liou MH, Ting HM, Chang L, Lee HY, Wan Leung S, Huang CJ, Chao PJ. Patient- and therapy-related factors associated with the incidence of xerostomia in nasopharyngeal carcinoma patients receiving parotid-sparing helical tomotherapy. Sci Rep 2015; 5:13165. [PMID: 26289304 PMCID: PMC4542473 DOI: 10.1038/srep13165] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Accepted: 07/02/2015] [Indexed: 11/08/2022] Open
Abstract
We investigated the incidence of moderate to severe patient-reported xerostomia among nasopharyngeal carcinoma (NPC) patients treated with helical tomotherapy (HT) and identified patient- and therapy-related factors associated with acute and chronic xerostomia toxicity. The least absolute shrinkage and selection operator (LASSO) normal tissue complication probability (NTCP) models were developed using quality-of-life questionnaire datasets from 67 patients with NPC. For acute toxicity, the dosimetric factors of the mean doses to the ipsilateral submandibular gland (Dis) and the contralateral submandibular gland (Dcs) were selected as the first two significant predictors. For chronic toxicity, four predictive factors were selected: age, mean dose to the oral cavity (Doc), education, and T stage. The substantial sparing data can be used to avoid xerostomia toxicity. We suggest that the tolerance values corresponded to a 20% incidence of complications (TD20) for Dis = 39.0 Gy, Dcs = 38.4 Gy, and Doc = 32.5 Gy, respectively, when mean doses to the parotid glands met the QUANTEC 25 Gy sparing guidelines. To avoid patient-reported xerostomia toxicity, the mean doses to the parotid gland, submandibular gland, and oral cavity have to meet the sparing tolerance, although there is also a need to take inherent patient characteristics into consideration.
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Affiliation(s)
- Tsair-Fwu Lee
- Medical Physics and Informatics Laboratory of Electronics Engineering, National Kaohsiung University of Applied Sciences, Kaohsiung 80778, Taiwan, ROC
- Graduate Institute of Clinical Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan, ROC
| | - Ming-Hsiang Liou
- Department of Electrical Engineering, National Kaohsiung University of Applied Sciences, Kaohsiung 80778, Taiwan, ROC
- Department of Radiation Oncology, Kaohsiung Yuan’s General Hospital, Kaohsiung 80249, Taiwan, ROC
| | - Hui-Min Ting
- Medical Physics and Informatics Laboratory of Electronics Engineering, National Kaohsiung University of Applied Sciences, Kaohsiung 80778, Taiwan, ROC
- Department of Radiation Oncology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 83342, Taiwan, ROC
| | - Liyun Chang
- Department of Medical Imaging and Radiological Sciences, I-Shou University, Kaohsiung 82445, Taiwan, ROC
| | - Hsiao-Yi Lee
- Department of Electrical Engineering, National Kaohsiung University of Applied Sciences, Kaohsiung 80778, Taiwan, ROC
| | - Stephen Wan Leung
- Department of Radiation Oncology, Kaohsiung Yuan’s General Hospital, Kaohsiung 80249, Taiwan, ROC
| | - Chih-Jen Huang
- Department of Radiation Oncology, Kaohsiung Medical University Chung-Ho Memorial Hospital, Kaohsiung 807, Taiwan, ROC
| | - Pei-Ju Chao
- Medical Physics and Informatics Laboratory of Electronics Engineering, National Kaohsiung University of Applied Sciences, Kaohsiung 80778, Taiwan, ROC
- Department of Radiation Oncology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 83342, Taiwan, ROC
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Lee TF, Chao PJ, Chang L, Ting HM, Huang YJ. Developing Multivariable Normal Tissue Complication Probability Model to Predict the Incidence of Symptomatic Radiation Pneumonitis among Breast Cancer Patients. PLoS One 2015; 10:e0131736. [PMID: 26147496 PMCID: PMC4492617 DOI: 10.1371/journal.pone.0131736] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Accepted: 06/04/2015] [Indexed: 11/20/2022] Open
Abstract
Purpose Symptomatic radiation pneumonitis (SRP), which decreases quality of life (QoL), is the most common pulmonary complication in patients receiving breast irradiation. If it occurs, acute SRP usually develops 4–12 weeks after completion of radiotherapy and presents as a dry cough, dyspnea and low-grade fever. If the incidence of SRP is reduced, not only the QoL but also the compliance of breast cancer patients may be improved. Therefore, we investigated the incidence SRP in breast cancer patients after hybrid intensity modulated radiotherapy (IMRT) to find the risk factors, which may have important effects on the risk of radiation-induced complications. Methods In total, 93 patients with breast cancer were evaluated. The final endpoint for acute SRP was defined as those who had density changes together with symptoms, as measured using computed tomography. The risk factors for a multivariate normal tissue complication probability model of SRP were determined using the least absolute shrinkage and selection operator (LASSO) technique. Results Five risk factors were selected using LASSO: the percentage of the ipsilateral lung volume that received more than 20-Gy (IV20), energy, age, body mass index (BMI) and T stage. Positive associations were demonstrated among the incidence of SRP, IV20, and patient age. Energy, BMI and T stage showed a negative association with the incidence of SRP. Our analyses indicate that the risk of SPR following hybrid IMRT in elderly or low-BMI breast cancer patients is increased once the percentage of the ipsilateral lung volume receiving more than 20-Gy is controlled below a limitation. Conclusions We suggest to define a dose-volume percentage constraint of IV20< 37% (or AIV20< 310cc) for the irradiated ipsilateral lung in radiation therapy treatment planning to maintain the incidence of SPR below 20%, and pay attention to the sequelae especially in elderly or low-BMI breast cancer patients. (AIV20: the absolute ipsilateral lung volume that received more than 20 Gy (cc).
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Affiliation(s)
- Tsair-Fwu Lee
- Medical Physics and Informatics Laboratory of Electronics Engineering, National Kaohsiung University of Applied Sciences, Kaohsiung 80778, Taiwan, ROC
- Graduate Institute of Clinical Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan, ROC
| | - Pei-Ju Chao
- Medical Physics and Informatics Laboratory of Electronics Engineering, National Kaohsiung University of Applied Sciences, Kaohsiung 80778, Taiwan, ROC
- Department of Radiation Oncology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, 83305, Taiwan, ROC
| | - Liyun Chang
- Department of Medical Imaging and Radiological Sciences, I-Shou University, Kaohsiung 82445, Taiwan, ROC
| | - Hui-Min Ting
- Medical Physics and Informatics Laboratory of Electronics Engineering, National Kaohsiung University of Applied Sciences, Kaohsiung 80778, Taiwan, ROC
- Department of Radiation Oncology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, 83305, Taiwan, ROC
| | - Yu-Jie Huang
- Department of Radiation Oncology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, 83305, Taiwan, ROC
- * E-mail:
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Lee TF, Liou MH, Huang YJ, Chao PJ, Ting HM, Lee HY, Fang FM. LASSO NTCP predictors for the incidence of xerostomia in patients with head and neck squamous cell carcinoma and nasopharyngeal carcinoma. Sci Rep 2014; 4:6217. [PMID: 25163814 PMCID: PMC5385804 DOI: 10.1038/srep06217] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2014] [Accepted: 08/08/2014] [Indexed: 02/04/2023] Open
Abstract
To predict the incidence of moderate-to-severe patient-reported xerostomia among head and neck squamous cell carcinoma (HNSCC) and nasopharyngeal carcinoma (NPC) patients treated with intensity-modulated radiotherapy (IMRT). Multivariable normal tissue complication probability (NTCP) models were developed by using quality of life questionnaire datasets from 152 patients with HNSCC and 84 patients with NPC. The primary endpoint was defined as moderate-to-severe xerostomia after IMRT. The numbers of predictive factors for a multivariable logistic regression model were determined using the least absolute shrinkage and selection operator (LASSO) with bootstrapping technique. Four predictive models were achieved by LASSO with the smallest number of factors while preserving predictive value with higher AUC performance. For all models, the dosimetric factors for the mean dose given to the contralateral and ipsilateral parotid gland were selected as the most significant predictors. Followed by the different clinical and socio-economic factors being selected, namely age, financial status, T stage, and education for different models were chosen. The predicted incidence of xerostomia for HNSCC and NPC patients can be improved by using multivariable logistic regression models with LASSO technique. The predictive model developed in HNSCC cannot be generalized to NPC cohort treated with IMRT without validation and vice versa.
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Affiliation(s)
- Tsair-Fwu Lee
- Medical Physics and Informatics Laboratory of Electronics Engineering, National Kaohsiung University of Applied Sciences, Kaohsiung, Taiwan, ROC
| | - Ming-Hsiang Liou
- Department of Electrical Engineering, National Kaohsiung University of Applied Sciences, Kaohsiung, Taiwan, ROC
- Department of Radiation Oncology, Kaohsiung Yuan's General Hospital, Kaohsiung, Taiwan, ROC
| | - Yu-Jie Huang
- Department of Radiation Oncology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan, ROC
| | - Pei-Ju Chao
- Medical Physics and Informatics Laboratory of Electronics Engineering, National Kaohsiung University of Applied Sciences, Kaohsiung, Taiwan, ROC
- Department of Radiation Oncology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan, ROC
| | - Hui-Min Ting
- Medical Physics and Informatics Laboratory of Electronics Engineering, National Kaohsiung University of Applied Sciences, Kaohsiung, Taiwan, ROC
- Department of Radiation Oncology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan, ROC
| | - Hsiao-Yi Lee
- Department of Electrical Engineering, National Kaohsiung University of Applied Sciences, Kaohsiung, Taiwan, ROC
| | - Fu-Min Fang
- Department of Radiation Oncology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan, ROC
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Chao PJ, Huang EY, Cheng KS, Huang YJ. Electrical impedance spectroscopy as electrical biopsy for monitoring radiation sequelae of intestine in rats. Biomed Res Int 2013; 2013:974614. [PMID: 24093111 PMCID: PMC3777171 DOI: 10.1155/2013/974614] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/29/2013] [Accepted: 08/05/2013] [Indexed: 11/17/2022]
Abstract
Electrical impedance is one of the most frequently used parameters for characterizing material properties. The resistive and capacitive characteristics of tissue may be revealed by electrical impedance spectroscopy (EIS) as electrical biopsy. This technique could be used to monitor the sequelae after irradiation. In this study, rat intestinal tissues after irradiation were assessed by EIS system based on commercially available integrated circuits. The EIS results were fitted to a resistor-capacitor circuit model to determine the electrical properties of the tissue. The variations in the electrical characteristics of the tissue were compared to radiation injury score (RIS) by morphological and histological findings. The electrical properties, based on receiver operation curve (ROC) analysis, strongly reflected the histological changes with excellent diagnosis performance. The results of this study suggest that electrical biopsy reflects histological changes after irradiation. This approach may significantly augment the evaluation of tissue after irradiation. It could provide rapid results for decision making in monitoring radiation sequelae prospectively.
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Affiliation(s)
- Pei-Ju Chao
- Department of Radiation Oncology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, No. 123, Ta-Pei Road, Niao-Sung, Kaohsiung 833, Taiwan
| | - Eng-Yen Huang
- Department of Radiation Oncology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, No. 123, Ta-Pei Road, Niao-Sung, Kaohsiung 833, Taiwan
| | - Kuo-Sheng Cheng
- Biomedical Imaging and Instrumentation Laboratory, Department of Biomedical Engineering, National Cheng Kung University, No. 1, University Road, Tainan 701, Taiwan
- Medical Device Innovation Center, National Cheng Kung University, No. 1, University Road, Tainan 701, Taiwan
| | - Yu-Jie Huang
- Department of Radiation Oncology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, No. 123, Ta-Pei Road, Niao-Sung, Kaohsiung 833, Taiwan
- Biomedical Imaging and Instrumentation Laboratory, Department of Biomedical Engineering, National Cheng Kung University, No. 1, University Road, Tainan 701, Taiwan
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Lee TF, Chao PJ, Wang HY, Hsu HC, Chang P, Chen WC. Normal tissue complication probability model parameter estimation for xerostomia in head and neck cancer patients based on scintigraphy and quality of life assessments. BMC Cancer 2012; 12:567. [PMID: 23206972 PMCID: PMC3536655 DOI: 10.1186/1471-2407-12-567] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2012] [Accepted: 11/24/2012] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND With advances in modern radiotherapy (RT), many patients with head and neck (HN) cancer can be effectively cured. However, xerostomia is a common complication in patients after RT for HN cancer. The purpose of this study was to use the Lyman-Kutcher-Burman (LKB) model to derive parameters for the normal tissue complication probability (NTCP) for xerostomia based on scintigraphy assessments and quality of life (QoL) questionnaires. We performed validation tests of the Quantitative Analysis of Normal Tissue Effects in the Clinic (QUANTEC) guidelines against prospectively collected QoL and salivary scintigraphic data. METHODS Thirty-one patients with HN cancer were enrolled. Salivary excretion factors (SEFs) measured by scintigraphy and QoL data from self-reported questionnaires were used for NTCP modeling to describe the incidence of grade 3+ xerostomia. The NTCP parameters estimated from the QoL and SEF datasets were compared. Model performance was assessed using Pearson's chi-squared test, Nagelkerke's R2, the area under the receiver operating characteristic curve, and the Hosmer-Lemeshow test. The negative predictive value (NPV) was checked for the rate of correctly predicting the lack of incidence. Pearson's chi-squared test was used to test the goodness of fit and association. RESULTS Using the LKB NTCP model and assuming n=1, the dose for uniform irradiation of the whole or partial volume of the parotid gland that results in 50% probability of a complication (TD50) and the slope of the dose-response curve (m) were determined from the QoL and SEF datasets, respectively. The NTCP-fitted parameters for local disease were TD50=43.6 Gy and m=0.18 with the SEF data, and TD50=44.1 Gy and m=0.11 with the QoL data. The rate of grade 3+ xerostomia for treatment plans meeting the QUANTEC guidelines was specifically predicted, with a NPV of 100%, using either the QoL or SEF dataset. CONCLUSIONS Our study shows the agreement between the NTCP parameter modeling based on SEF and QoL data, which gave a NPV of 100% with each dataset, and the QUANTEC guidelines, thus validating the cut-off values of 20 and 25 Gy. Based on these results, we believe that the QUANTEC 25/20-Gy spared-gland mean-dose guidelines are clinically useful for avoiding xerostomia in the HN cohort.
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Affiliation(s)
- Tsair-Fwu Lee
- Medical Physics and Informatics Laboratory, Department of Electronics Engineering, National Kaohsiung University of Applied Sciences, Kaohsiung, Taiwan, ROC
| | - Pei-Ju Chao
- Medical Physics and Informatics Laboratory, Department of Electronics Engineering, National Kaohsiung University of Applied Sciences, Kaohsiung, Taiwan, ROC
- Department of Radiation Oncology, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan, ROC
| | - Hung-Yu Wang
- Medical Physics and Informatics Laboratory, Department of Electronics Engineering, National Kaohsiung University of Applied Sciences, Kaohsiung, Taiwan, ROC
| | - Hsuan-Chih Hsu
- Department of Radiation Oncology, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan, ROC
| | - PaoShu Chang
- Department of Radiation Oncology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan, ROC
- Department of Medical Imaging and Radiological Sciences, Kaohsiung Medical University, Kaohsiung, Taiwan, ROC
| | - Wen-Cheng Chen
- Departments of Radiation Oncology, Chang Gung Memorial Hospital, Chiayi, Taiwan, ROC
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Lee TF, Chao PJ, Ting HM, Lo SH, Wang YW, Tuan CC, Fang FM, Su TJ. Comparative analysis of SmartArc-based dual arc volumetric-modulated arc radiotherapy (VMAT) versus intensity-modulated radiotherapy (IMRT) for nasopharyngeal carcinoma. J Appl Clin Med Phys 2011; 12:3587. [PMID: 22089015 PMCID: PMC5718754 DOI: 10.1120/jacmp.v12i4.3587] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2011] [Revised: 05/17/2011] [Accepted: 05/24/2011] [Indexed: 12/15/2022] Open
Abstract
The purpose of this study was to evaluate and quantify the planning performance of SmartArc‐based volumetric‐modulated arc radiotherapy (VMAT) versus fixed‐beam intensity‐modulated radiotherapy (IMRT) for nasopharyngeal carcinoma (NPC) using a sequential mode treatment plan. The plan quality and performance of dual arc‐VMAT (DA‐VMAT) using the Pinnacle3 Smart‐Arc system (clinical version 9.0; Philips, Fitchburg, WI, USA) were evaluated and compared with those of seven‐field (7F)‐IMRT in 18 consecutive NPC patients. Analysis parameters included the conformity index (CI) and homogeneity index (HI) for the planning target volume (PTV), maximum and mean dose, normal tissue complication probability (NTCP) for the specified organs at risk (OARs), and comprehensive quality index (CQI) for an overall evaluation in the 11 OARs. Treatment delivery time, monitor units per fraction (MU/fr), and gamma (Γ3mm,3%) evaluations were also analyzed. DA‐VMAT achieved similar target coverage and slightly better homogeneity than conventional 7F‐IMRT with a similar CI and HI. NTCP values were only significantly lower in the left parotid gland (for xerostomia) for DA‐VMAT plans. The mean value of CQI at 0.98±0.02 indicated a 2% benefit in sparing OARs by DA‐VMAT. The MU/fr used and average delivery times appeared to show improved efficiencies in DA‐VMAT. Each technique demonstrated high accuracy in dose delivery in terms of a high‐quality assurance (QA) passing rate (>98%) of the (Γ3mm,3%) criterion. The major difference between DA‐VMAT and 7F‐IMRT using a sequential mode for treating NPC cases appears to be improved efficiency, resulting in a faster delivery time and the use of fewer MU/fr. PACS number: 87.53.Tf, 87.55.x, 87.55.D, 87.55.dk
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Affiliation(s)
- Tsair-Fwu Lee
- Medical Physics & Informatics Lab., Department of Electronics Engineering, National Kaohsiung University of Applied Sciences, Kaohsiung, Taiwan.
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Wan Leung S, Lee TF, Chien CY, Chao PJ, Tsai WL, Fang FM. Health-related quality of life in 640 head and neck cancer survivors after radiotherapy using EORTC QLQ-C30 and QLQ-H&N35 questionnaires. BMC Cancer 2011; 11:128. [PMID: 21486431 PMCID: PMC3083374 DOI: 10.1186/1471-2407-11-128] [Citation(s) in RCA: 74] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2010] [Accepted: 04/12/2011] [Indexed: 11/18/2022] Open
Abstract
Background With the advances in modern radiotherapy (RT), many patients with head and neck cancer (HNC) can be effectively cured, and their health-related quality of life (HR-QoL) has become an important issue. In this study, we evaluated the prognosticators of HR-QoL in a large cohort of HNC patients, with a focus on the result from technological advances in RT. Methods A cross-sectional investigation was conducted to assess the HR-QoL of 640 HNC patients with cancer-free survival of more than 2 years. Among them, 371 patients were treated by two-dimensional RT (2DRT), 127 by three-dimensional conformal RT (3DCRT), and 142 by intensity-modulated RT (IMRT). The EORTC QLQ-C30 questionnaire and QLQ-H&N35 module were used. A general linear model multivariate analysis of variance was used to analyze the prognosticators of HR-QoL. Results By multivariate analysis, the variables of gender, annual family income, tumor site, AJCC stage, treatment methods, and RT technique were prognosticators for QLQ-C30 results, so were tumor site and RT technique for H&N35. Significant difference (p < 0.05) of HR-QoL outcome by different RT techniques was observed at 2 of the 15 scales in QLQ-C30 and 10 of the 13 scales in H&N35. Compared with 2DRT, IMRT had significant better outcome in the scales of global QoL, physical functioning, swallowing, senses (taste/smell), speech, social eating, social contact, teeth, opening mouth, dry mouth, sticky saliva, and feeling ill. Conclusions The technological advance of RT substantially improves the head-and-neck related symptoms and broad aspects of HR-QoL for HNC survivors.
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Affiliation(s)
- Stephen Wan Leung
- Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan
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Lee TF, Chao PJ, Fang FM, Su TJ, Leung SW, Hsu HC. Helical tomotherapy for single and multiple liver tumours. Radiat Oncol 2010; 5:58. [PMID: 20576108 PMCID: PMC2900282 DOI: 10.1186/1748-717x-5-58] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2010] [Accepted: 06/24/2010] [Indexed: 12/25/2022] Open
Abstract
Purpose Dosimetric evaluations of single and multiple liver tumours performed using intensity-modulated helical tomotherapy (HT) were quantitatively investigated. Step-and-shoot intensity-modulated radiotherapy (SaS-IMRT) was used as a benchmark. Methods Sixteen patients separated into two groups with primary hepatocellular carcinomas or metastatic liver tumours previously treated using SaS-IMRT were examined and re-planned by HT. The dosimetric indices used included the conformity index (CI) and homogeneity index (HI) for the planned target volume (PTV), max/mean dose, quality index (QI), normal tissue complication probability (NTCP), V30 Gy, and V50% for the specified organs at risk (OARs). The monitor units per fraction (MU/fr) and delivery time were also analysed. Results For the single tumour group, both planning systems satisfied the required PTV prescription, but no statistical significance was shown by the indexes checking. A shorter delivery time and lower MU/fr value were achieved by the SaS-IMRT. For the group of multiple tumours, the average improvement in CI and HI was 14% and 4% for HT versus SaS-IMRT, respectively. Lower V50%, V30 Gy and QI values were found, indicating a significant dosimetric gain in HT. The NTCP value of the normal liver was 20.27 ± 13.29% for SaS-IMRT and 2.38 ± 2.25% for HT, indicating fewer tissue complications following HT. The latter also required a shorter delivery time. Conclusions Our study suggests dosimetric benefits of HT over SaS-IMRT plans in the case of multiple liver tumours, especially with regards sparing of OARs. No significant dosimetric difference was revealed in the case of single liver tumour, but SaS-IMRT showed better efficiency in terms of MU/fr and delivery time.
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Affiliation(s)
- Tsair-Fwu Lee
- Medical Physics and Informatics Lab, (EE), National Kaohsiung University of Applied Sciences, Kaohsiung, Taiwan.
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Lee TF, Chao PJ, Wang CY, Lan JH, Huang YJ, Hsu HC, Sung CC, Su TJ, Lian SL, Fang FM. Dosimetric comparison of helical tomotherapy and dynamic conformal arc therapy in stereotactic radiosurgery for vestibular schwannomas. Med Dosim 2010; 36:62-70. [PMID: 20188537 DOI: 10.1016/j.meddos.2009.11.005] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2009] [Revised: 11/23/2009] [Accepted: 11/24/2009] [Indexed: 11/29/2022]
Abstract
The dosimetric results of stereotactic radiosurgery (SRS) for vestibular schwannoma (VS) performed using dynamic conformal arc therapy (DCAT) with the Novalis system and helical TomoTherapy (HT) were compared using plan quality indices. The HT plans were created for 10 consecutive patients with VS previously treated with SRS using the Novalis system. The dosimetric indices used to compare the techniques included the conformity index (CI) and homogeneity index (HI) for the planned target volume (PTV), the comprehensive quality index (CQI) for nine organs at risk (OARs), gradient score index (GSI) for the dose drop-off outside the PTV, and plan quality index (PQI), which was verified using the plan quality discerning power (PQDP) to incorporate 3 plan indices, to evaluate the rival plans. The PTV ranged from 0.27-19.99 cm(3) (median 3.39 cm(3)), with minimum required PTV prescribed doses of 10-16 Gy (median 12 Gy). Both systems satisfied the minimum required PTV prescription doses. HT conformed better to the PTV (CI: 1.51 ± 0.23 vs. 1.94 ± 0.34; p < 0.01), but had a worse drop-off outside the PTV (GSI: 40.3 ± 10.9 vs. 64.9 ± 13.6; p < 0.01) compared with DCAT. No significant difference in PTV homogeneity was observed (HI: 1.08 ± 0.03 vs. 1.09 ± 0.02; p = 0.20). HT had a significantly lower maximum dose in 4 OARs and significant lower mean dose in 1 OAR; by contrast, DCAT had a significantly lower maximum dose in 1 OAR and significant lower mean dose in 2 OARs, with the CQI of the 9 OARs = 0.92 ± 0.45. Plan analysis using PQI (HT 0.37 ± 0.12 vs. DCAT 0.65 ± 0.08; p < 0.01), and verified using the PQDP, confirmed the dosimetric advantage of HT. However, the HT system had a longer beam-on time (33.2 ± 7.4 vs. 4.6 ± 0.9 min; p < 0.01) and consumed more monitor units (16772 ± 3803 vs. 1776 ± 356.3; p < 0.01). HT had a better dose conformity and similar dose homogeneity but worse dose gradient than DCAT. Plan analysis confirmed the dosimetric advantage of HT, although not all indices revealed a better outcome for HT. Whether this dosimetric advantage translates into a clinical benefit deserves further investigation.
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Affiliation(s)
- Tsair-Fwu Lee
- National Kaohsiung University of Applied Sciences, Kaohsiung, Taiwan.
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Lee TF, Fang FM, Chao PJ, Su TJ, Wang LK, Leung SW. Dosimetric comparisons of helical tomotherapy and step-and-shoot intensity-modulated radiotherapy in nasopharyngeal carcinoma. Radiother Oncol 2008; 89:89-96. [PMID: 18524401 DOI: 10.1016/j.radonc.2008.05.010] [Citation(s) in RCA: 79] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2008] [Revised: 05/02/2008] [Accepted: 05/03/2008] [Indexed: 11/28/2022]
Abstract
PURPOSE The study evaluates and quantifies the potential dosimetric gains of helical tomotherapy (HT) versus step-and-shoot intensity-modulated radiotherapy (SaS-IMRT) for nasopharyngeal carcinoma (NPC). MATERIALS AND METHODS Twenty consecutive NPC patients curatively treated by HT were examined. Each case was planned by HT and SaS-IMRT (ADAC Pinnacle(3)) planning system, respectively. Dose plans were compared using dose volume histograms (DVH), conformity index (CI), homogeneity index (HI), and minimal dose to 1cc (D(min_1cc)) of the planned target volume (PTV) and a comprehensive quality index (CQI) of ten organs at risk (OARs). The prescribed dose/fractionation was 72Gy to the PTV, 64.8Gy to the elective PTV, and 54Gy to the clinically negative neck region. The plan of 54Gy to the PTV (PTV(54)) was used to evaluate the CI and HI in the target. The cumulative doses of the three PTV plans to the OARs were calculated. RESULTS We observed the HT plans significantly improved the CI (improvement ratio: 11.9+/-5.5%) and HI (improvement ratio: 8.8+/-1.5%) of the PTV(54) compared with SaS-IMRT plans. In addition, the mean/maximal dose of most of the OARs except chiasm was significantly reduced in HT plans, with the CQI of 0.92+/-0.08. A negative result of HT in chiasm was observed but only significantly revealed in cases without skull base infiltration. CONCLUSIONS A dosimetric gain in CI and HI of PTV and sparing of OARs was significantly obtained in HT versus SaS-IMRT plans in NPC patients. Whether such dosimetric superiority in HT could transfer into clinical advantages needs further investigation.
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Affiliation(s)
- Tsair-Fwu Lee
- National Kaohsiung University of Applied Sciences, Kaohsiung, Taiwan, ROC
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Lee WI, Chang TH, Chao PJ. THE RELATIONSHIP BETWEEN QUALITY OF HEALTHCARE SERVICE AND CUSTOMER SATISFACTION- AN EXAMPLE OF HOSPITALS IN TAIWAN. ACTA ACUST UNITED AC 2007. [DOI: 10.1080/10170660709509024] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Chang TC, Lai CH, Hong JH, Hsueh S, Huang KG, Chou HH, Tseng CJ, Tsai CS, Chang JT, Lin CT, Chang HH, Chao PJ, Ng KK, Tang SG, Soong YK. Randomized trial of neoadjuvant cisplatin, vincristine, bleomycin, and radical hysterectomy versus radiation therapy for bulky stage IB and IIA cervical cancer. J Clin Oncol 2000; 18:1740-7. [PMID: 10764435 DOI: 10.1200/jco.2000.18.8.1740] [Citation(s) in RCA: 88] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To compare the efficacy of neoadjuvant chemotherapy (NAC) followed by radical hysterectomy with that of radiotherapy (R/T) for bulky early-stage cervical cancer. PATIENTS AND METHODS Women with previously untreated bulky (primary tumor >/= 4 cm) stage IB or IIA non-small-cell carcinoma of the uterine cervix were randomly assigned to receive either cisplatin 50 mg/m(2) and vincristine 1 mg/m(2) for 1 day and bleomycin 25 mg/m(2) for 3 days for three cycles followed by radical hysterectomy (NAC arm) or receive primary pelvic radiotherapy only (R/T arm). The ratio of patient allocation was 6:4 for the NAC and R/T arms. Women with enlarged para-aortic lymph nodes on image study were ineligible unless results of cytologic or histologic studies were negative. RESULTS Of the 124 eligible patients, 68 in the NAC arm and 52 in the R/T arm could be evaluated. The median duration of follow-up was 39 months. Thirty-one percent of patients in the NAC arm and 27% in the R/T arm had relapse or persistent diseases after treatment, and 21% in each group died of disease. Estimated cumulative survival rates at 2 years were 81% for the NAC arm and 84% for the R/T arm; the 5-year rates were 70% and 61%, respectively. There were no significant differences in disease-free survival and overall survival. CONCLUSION NAC followed by radical hysterectomy and primary R/T showed similar efficacy for bulky stage IB or IIA cervical cancer. Further study to identify patient subgroups better suited for either treatment modality and to evaluate the concurrent use of cisplatin and radiation without routine hysterectomy is necessary.
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Affiliation(s)
- T C Chang
- Departments of Obstetrics and Gynecology (Division of Gynecologic Oncology), Pathology, Radiation Oncology, and Diagnostic Radiology, and Biostatistics Consulting Center, Chang Gung Memorial Hospital Linkou Medical Center, Taoyuan, Taiwan
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